It is time for you to focus on educating your federal legislators about home oxygen therapy.
We have one simple message for now: Requiring beneficiaries to own complex home oxygen medical equipment presents serious patient safety issues. Therefore, Congress must repeal the provision in the Deficit Reduction Act that requires beneficiaries on home oxygen therapy to own the equipment after a 36-month rental period.
When contacting members of Congress about the oxygen provision, make the following points:
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Medical oxygen only can be prescribed by a physician specifically for individual patient use. Oxygen is a drug and can be dangerous if not administered or used properly. Oxygen dispensing equipment also is a prescription device that can only be dispensed upon a physician prescription. Patient ownership will produce the undesired effect of unmonitored and unregulated dispensing and distribution of a prescription drug.
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Use of medical oxygen equipment is imperative to the overall well-being of patients on oxygen therapy. Home care companies currently provide 24-hour, emergency on-call service to assist patients with troubleshooting equipment problems, improper use, equipment failures or emergency services in the event of electrical outages.
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With the transfer of ownership of the medical device to the patient, the control over the dosage levels shifts to the patient, increasing the risk of self-medication to the patient's own detriment. This is an unreasonable burden and worry for seniors.
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Beyond 24/7 access, the Joint Commission on Accreditation of Healthcare Organizations and other independent accrediting bodies include standards that ensure safe and effective clinical respiratory services are delivered in the home. The oxygen provision is in direct violation of quality standards that have been in existence since the late 1980s and which CMS is currently considering for adoption under competitive bidding.
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Routine services currently are provided by the home oxygen suppliers as part of the monthly rental fee. Without an adequate Medicare coding, coverage and payment structure to support the provision of these services, it is unclear how beneficiaries will access these necessary services once equipment ownership transfers to the beneficiary.
These services include: ensuring that patients can adequately manage their oxygen in the event of emergencies that affect power or damage their homes; verifying the purity of the oxygen delivered to the patient (without this verification, a patient could unknowingly be receiving subtherapeutic levels of oxygen, which could adversely and severely affect the patient's medical condition, requiring emergency care and/or hospitalization).
Services also include utilizing a flow verification device (a respiratory therapist or specially trained technician regularly verifies the actual prescription being delivered to the patient. Oxygen is a federal legend drug and, just as with many other medications, too little is ineffective and too much can be potentially fatal for some patients).
Verification of alarm system functions assures the patient and/or caregivers will be awakened to place the patient on a back-up oxygen system should the home lose electricity or the oxygen concentrator fail to operate properly. Suppliers also check and replace internal and external filter systems; deliver disposable oxygen accessories such as humidifiers, supply tubing, filters, nasal cannulas, trach masks, corrugated tubing, in-line adaptors and other miscellaneous devices; and handle home delivery, set up, patient/caregiver instructions of safety and use, pick-up and replacement of malfunctioning equipment, depleted tanks and reserve systems.
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The loss of title to the oxygen equipment will serve as a disincentive for providers to invest in advancing technology. As a result, manufacturers will shift research and development efforts away from the development of smaller, lighter, longer-lasting portable systems and robust low-maintenance technology, instead focusing on the development of cheaper, less-expensive devices. This will lead to a higher probability of equipment malfunction, unacceptable levels of oxygen and increased maintenance and repair costs during the later “useful life” of the equipment.
A specialist in health care legislation, regulations and government relations, Cara C. Bachenheimer is vice president, government relations, for Invacare Corp., Elyria, Ohio. Bachenheimer previously worked at the law firm of Epstein, Becker & Green in Washington, D.C., and at the American Association for Homecare and the Health Industry Distributors Association. You can reach her by phone at 440/329-6226 or by e-mail at cbachenheimer@invacare.com.
